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Whipple's disease is caused by an infection of bacteria. It can involve many organ systems including the joints, eyes, gut, lymph nodes, heart, and brain. It usually affects white men in the 40-60 year age range.
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- Symptoms can be different depending on which part of the body is infected. Often, the symptoms are very difficult to detect.
- Up to 80% of patients have joint pain or joint inflammation. Often, this is the first symptom.
- About 75% of patients also develop stomach problems. The symptoms can include abdominal pain, Diarrhea, weight
loss, and weakness. Also, there can be problems with absorbing nutrients from the stomach and intestines. This can lead to low blood counts, cramps in the muscles, bone pain or bone fractures, easy Bruising, or swelling of the stomach or legs.
- Others develop a chronic cough, enlarged lymph nodes, Heart Failure, heart murmurs, low-grade fevers, or eye problems.
- 10% of patients develop neurological symptoms such as confusion, excessive sleepiness, or even seizures.
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- This disease is caused by the bacteria Tropheryma whippelii. It is not usually spread from person to person.
- The bacteria can infect different parts of the body and cause a variety of symptoms.
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- A diagnosis is made by a biopsy, which involves obtaining a piece of tissue from the effected organ and looking at it under the microscope. The most common area that the tissue is obtained from is the upper part of the intestines.
- Newer tests allow testing of the tissue using PCR, which is much better at detecting the organism.
- Other lab tests may also be abnormal, especially if there is a problem absorbing nutrients. The abnormal labs can include: low blood counts, low cholesterol, low Calcium, low iron, increased bleeding times, low protein, low Magnesium, and low B12 levels.
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- Antibiotic treatment can lead to significant improvement in the symptoms. Patients improve almost completely within 1-3 months. However, many patients develop repeat infections. Therefore, patients are usually treated with antibiotics for at least 1 year.
- The antibiotic of choice is Trimethoprim-sulfamethoxazole -- one double strength pill twice a day for a year. If patients are allergic to sulfa drugs, then Ceftriaxone or Chloramphenicol can be used.
- New experimental treatments with interferon gamma are being studied.
- After treatment, a repeat biopsy can be done to make sure the organism has been destroyed.
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